- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date...Torts Reports to: Deputy Executive Assistant General Counsel - Appeals Work Location: 130 Livingston St. Brooklyn Hours of… more
- Molina Healthcare (Buffalo, NY)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... group of employees responsible for submission, intervention and resolution of appeals , grievances, and/or complaints from Molina members, providers and related… more
- Molina Healthcare (Yonkers, NY)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- City of New York (New York, NY)
- …Department is seeking applicants for an Assistant Corporation Counsel position in its Appeals Division. The Appeals Division handles appeals originating from ... before federal and state appellate courts and are responsible for briefing and arguing appeals in an array of cases, from routine litigation arising out of the… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Centene Corporation (New York, NY)
- …Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- MTA (Brooklyn, NY)
- Executive Agency Counsel, Appeals Job ID: 12747 Business Unit: MABSTOA Location: Brooklyn, NY, United States Regular/Temporary: Regular Department: Torts Date ... 27, 2025 Description Job Information Executive Agency Counsel, Non-Managerial (Level A & B)- Appeals First Date of Posting: 8/19/2025 Last Date of Posting: Open Until… more
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied...reviews of previously denied cases in which a formal appeals request has been made or upon request by… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more